Delayed Graft Function (DGF) and Acute Rejection (AR) are associated with an increased risk of graft loss. It is unclear whether this is a result of reduced kidney function due to the acute clinical event or whether these events trigger a longitudinal decline in kidney function.

We examined the association of DGF and AR within the 1st year post-transplant with eGFR at 1 year after transplantation and the annualized change in eGFR between 1 and 3 years post-transplant among all n=65,512 adult deceased donor kidney transplant recipients transplanted between 2000-09, using data from USRDS. The annualized change in eGFR was determined using repeated measures linear regression and the relative change in the slope of eGFR was compared between patients who developed DGF or AR compared to patients with neither clinical event using multivariable linear regression after adjustment for relevant confounders including eGFR at 1 year.

The mean eGFR at 1 year was 54(+/- 19), 48(+/- 120), 43(+/- 19), and 60 (+/- 19) ml/min when DGF, AR, both DGF and AR, and neither DGF or AR occurred (p<0.001). Both AR and DGF were associated with a more rapid rate of eGFR decline post-transplant, but this was more dramatic with AR(table). These results were consistent when stratified by level of eGFR at 1 year (table).

These results support the belief that both DGF and AR have a long-standing impact on allograft function and implies that this is

mediated through both an early acute injury and a progressive decline in kidney function thereafter.

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